SBHC 101: Nuts and Bolts of Starting a ... - Community Schools › assets › 1 › AssetManager...Successful School-Based Health Center in a Community School Laura Brey, MS, NASBHC

SBHC 101: Nuts and Bolts of Starting a

Successful School-Based Health Center

in a Community School

Laura Brey, MS, NASBHC Training Director

Lisa Handwerker, MD, FAAP, Medical Director, The Children’s Aid Society

Coalition for Community Schools, 2010 National Forum

April 7, 2010

2

Objectives

Define the term school-based health center.

Describe three national school-based health care models

List the five nuts and bolts for planning and implementing a successful school-based health center

Our Vision

All children and adolescents are healthy and

achieving at their fullest potential.

Our Mission

To improve the health status of children and youth

by advancing and advocating for school-based

health care

Adopted by Board of Directors, January 2009

Adopted by Board of Directors, January 2009

Our Core Values

NASBHC believes that:• Children and adolescents need high quality, accessible, culturally competent,

comprehensive health care.

• The school setting is a sensible and appropriate place to deliver health care

because that is where the students are.

• Ideally, the full scope of services is provided directly in a SBHC; alternative models

may be dictated by resources and the needs of the community.

• SBHCs reduce health inequities and improve health outcomes for underserved youth.

• SBHCs should be fairly reimbursed for the high-quality health services they provide.

NASBHC Membership

Individual $75 ($25 student)

A national voice advocating for SBHCs at the Federal level

Quarterly newsletter

Events calendar

Online renewal

Free access to NASBHC publications

Access to members-only space on NASBHC.org

– Searchable member directory

– Archived issues of the newsletter

– Special member updates

– Archived NASBHC Web

conferences

Free access to NASBHC toolkits

Organizational $500

All of the benefits of an individual membership, AND

Two individual memberships

Access to job board with ability to post positions

50 customizable postcards promoting the SBHC model

E-mail updates and action alerts for the entire staff (requires submission of a staff e-mail roster)

6

What is a School-Based Health

Center (SBHC)?

7

SBHC: National Definition

Partnerships created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children and adolescents.

One of the partners, usually a health agency (community health center, local health department, hospital, mental health agency, or 501 C3 agency), or a school system, becomes the sponsoring agency.

8


Services provided by the school-based health care team are determined locally through a collaborative process that includes families and students, communities, school districts, and individual and agency health care providers.

The school-based health care team works in collaboration with school nurses and other service providers in the school and community.

9


SBHCs have a policy on parental consent.

Although the model may vary based on availability of resources and community needs, SBHCs are typically open every school day, and staffed by an interdisciplinary team of medical and mental health professionals that provide comprehensive medical, mental health and health education services.

10


SBHCs make provisions for care beyond the centers’ operating hours or scope of service.

Because of the unique vantage point and access to students, the health center team is able to reach out to students to emphasize prevention and early intervention.

11


Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth.

These services may include but are not limited to: – primary care for acute and chronic health conditions

– mental health services

– substance abuse services

– case management

– dental health services

– reproductive health care

– nutrition education

– health education and health promotion.

12


SBHCs are supported by local, state, and federal public health and primary care grants, community foundations, students and families, and reimbursement from public and private health insurance.

13

Why School-Based Health Centers?

Group Activity

Why School-Based Health Centers?

– Think of yourself as a school aged child, pick

your age, or

– Think of your own child or adolescent, or

– Think of family members, neighbors as a school

aged child

– Using the first letter of your first or last name, or

draw an alphabet card, come up with a reason

for having a SBHC in your community

15

Why SBHCs?

Uninsurance among children, especially adolescents

Geographic and financial barriers to health, mental health, and oral health

Dangerous health outcomes associated with adolescents

Nonexistent/fragmented/singular discipline systems of care

Decreased educational attainment

16

“Health services need to be where students can trip over them. Adolescents do not carry appointment books, and school is the only place where they are required to spend time.”

Philip J. Porter, M.D.

Early architect of the SBHC movement

17

The Evidence Base for SBHCs

Research published in professional literature

National and state data

– National State Initiative Survey

– NASBHC Triennial census

– White papers

Training and technical assistance in the field

– Results of beta testing tools and resources

– Collaboratives

Pre and post assessments, chart reviews,

progress reports, storyboards, consultation calls

18

What the Literature Tell Us About

Emergency Room Use and SBHCs

Reduced inappropriate emergency room use,

Increased use of primary care, and

Fewer hospitalizationsSantelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275

Prevention-oriented care in SBHCs results in decreased utilization of emergency departments

Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273

19


Asthma and SBHCs

Greater than 50% reduction in asthma-related emergency room visits for students enrolled in SBHCs in New York City

Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: 125-129

$3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City

Analysis by the Empire Health Group for the NY Coalition of School-Based Primary Care, 2005

20


Mental Health and SBHCs

SBHCs attract harder-to-reach populations, especially minorities and males and do a better job at getting them crucial services such as mental health care and high risk screens.

Adolescents were 10-21 times more likely to come to a SBHC for mental health services than a community health center network or HMO.

Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health 2003; 32S:108-118.

Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998

Jan;152(1):25-33.

What Science Tell Us About Education

and SBHCs

Health has both direct and indirect effects on school failure

Good education predicts good health

Inequities in health and education are closely linked:

young people who experience inequities in educational

achievement also experience inequities in health care

access

Public health and education are linked toward a common cause: student success

21

What We Know Intuitively

Healthy students make better learners

You cannot teach a child who is not healthy

A child who succeeds in school is more likely to enjoy lifelong health

22

What Science Tells Us About

Education Academic performance is negatively affected by:

– Alcohol, tobacco, and other drug use

– Emotional problems

– Poor diet

– Intentional injuries

– Physical illness

– Low self-esteem

– Risky sexual behavior

– Lack of access to health care

– Unstable home environment

Academic performance is positively affected by:– High levels of resiliency, developmental assets, and school

connectedness.

23

SBHCs

Health Risk

BehaviorsSubstance use

Mental health

Poor diet

Intentional injuries

Physical illness

Self-esteem

Sexual behaviors

Attendance

Dropout Rates

Behavioral Problems

Graduation

GPA

Standardized test scores

Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection?

April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.

The Health-Academic Outcomes Connection

24

SBHC Outcomes and Tactics

Reduce barriers to learning

Increase attendance

Improve student health

Meet government regulations

• Identify students at-risk for health and behavioral problems

• Assist in IEP development

• Provide mental health services

• Treat acute conditions

• Manage chronic conditions

• Provide preventive health services


• Administer medication to students with chronic conditions

• Enroll students in health insurance


• Refer students to services not provided in the SBHC

• Provide preventive health services


• Manage chronic conditions

• Conduct sports physicals


• Immunize students

• Participate in community initiatives on public health such as obesity and emergency planning

• Maintain health records for migratory students

25

26

The Medical Home

Half of SBHCs estimate more than 30% of their enrollees use the center as their medical home

40% of SBHCs estimate 50% or more of their enrollees use the center as their medical home

27

Efficiencies in SBHCs

Parents do not need to take time off

Follow-up is less labor intensive

Ability to identifying problems earlier

Costly emergency room visits reduced

28

National Data and Trends

Census 2007-08

29

2007-08 National SBHC Census

Total number of SBHCs = 1910

Total number of respondents = 1226

Response rate 64% (1226/1910)

Completed by person most knowledgeable about clinical care

30

SBHCs by State (n=1910)

State Total # of Open SBHCs State Total # of Open SBHCs

Alabama 5 Nebraska 1

Alaska 3 Nevada 6

Arizona 81 New Hampshire 1

Arkansas 2 New Jersey 40

California 160 New Mexico 79

Colorado 45 New York 206

Connecticut 79 North Carolina 49

Delaware 28 Ohio 20

District of Columbia 4 Oklahoma 11

Florida 245 Oregon 51

Georgia 3 Pennsylvania 28

Illinois 60 Puerto Rico 2

Indiana 87 Rhode Island 2

Iowa 16 Saskatchewan 1

Kansas 2 South Carolina 7

Kentucky 20 South Dakota 6

Louisiana 64 Tennessee 21

Maine 26 Texas 70

Maryland 71 Utah 5

Massachusetts 59 Vermont 5

Michigan 90 Virginia 19

Minnesota 16 Washington 20

Mississippi 31 West Virginia 50

Missouri 3 Wisconsin 8

31

SBHCs by Location (n=1226)

In school building 95.7 percent

On school property 2.9 percent

Mobile 1.4 percent

32

SBHCs by types of School (n=1096)

33

SBHCs by Community Characteristic (n=1235)

34

SBHCs by Population Served (n=1096)

35

SBHCs by Sponsoring Agency (n=1096)

36

SBHC Service

Delivery Models

37

Primary Care Only Model

Medical provider (NP/PA/MD) 1-5 days/week

Full or part-time (FT/PT) coverage

No mental health or substance abuse services

38

Primary Care/Mental Health Model

PT or FT coverage

Full range of prevention/early intervention physical and behavioral health services (age and developmentally appropriate, e.g. reproductive health)

Diagnosis, treatment and management of minor acute and chronic illnesses

Provision for after-hours care

39

Staffing for Primary Care/Mental

Health Model

Medical provider (NP/PA/MD)

School nurse (if present)

Mental Health provider

– Clinical Social Worker

– Psychologist/Psychiatrist

May include substance abuse counselor

40

Primary Care/Mental Health PLUS

Model

FT coverage if possible

Primary care and mental health plus:(one or more of the following)

– Dental services

– Reproductive health services that include contraception dispensing/prescribing

– Nutrition counseling

– On-site substance abuse treatment

41

Staffing for Primary Care/Mental

Health PLUS Model

School nurse

Medical provider (NP/PA/MD)

Mental health provider

Dentist/Dental hygienist

Addictions counselor

Nutritionist

Health educator

Social worker

42

SBHCs by Staffing Model (N=1017)

43

Alternative Models: Services

and Staffing

School-Linked Health Centers• Can mirror the service and staffing patterns of

primary care only, primary care-mental health, and primary care-mental health PLUS models

Mobile Health Centers• Can mirror the service and staffing patterns of

primary care only, primary care-mental health, and primary care-mental health PLUS models

Examples of Commonly Raised

Concerns and IssuesThe following are issues that typically

arise when discussing SBHCs and being prepared to answer adequately is the best strategy.

– Reproductive Health

– Parental Consent

– Cost

– Why in a school setting – resources

concern

45

Participant Expectations

Complete the index card and hand it in.

NASBHC

Roadmap

NASBHC

Roadmap

48

Collaboration and Partnerships

Nut and Bolt #1

Collaborative Partnerships

A mutually beneficial and well-defined relationship among two or more organizations to JOINTLY develop structure

• Responsibility

• Resources

• Authority

• Accountability

• Rewards

Why have a Collaboration?

To accomplish a common goal that none of the units can attain alone

To help agencies share information, resources, staff, and equipment

To create and share an awareness of needs, challenges, and opportunities

Characteristics of a Successful

Collaboration

Concrete, achievable work plan and goals

Well-defined leadership

Clear roles and responsibilities

Mutually respectful environment that facilitates commitment and sharing of ideas

Cooperative teams

Characteristics of a Successful

Collaboration Established core team

Transparent processes

Exchange and respect knowledge and talent

Shared decision making

53

Establish a Planning Group

Composition Considerations

• Local health department

• Community or rural health center

• Community and/or teaching hospital(s)

• Mental health, substance abuse, and social service agencies

• Private physicians

• University faculty

• Elected Officials

• Business and community leaders

• Faith community

• School superintendent, board, or designee

• School administration and Faculty (school nurse, teachers, principals, guidance counselors, physical education, nutrition/food services)

• Students

• Parents

55

Conduct the Needs Assessment

Nut and Bolt #2

56

What is a Community Needs

Assessment?

A process for:

identifying needs and resources in a community

determining gaps between what a situation is and what it should be

establishing priorities

An opportunity to paint a picture of the conditions in a community and sharpen your perceptions of the critical issues children and families face.

Why conduct a needs assessment?

An accurate appraisal of the current situation (strengths, concerns, and general conditions) of a community’s population

An opportunity to paint a picture of the conditions and sharpen your perceptions of the critical issues children and families face

Outcome of a needs assessment

Better understanding of your community

Document need to rally supporters and

funders

Increased awareness of strengths and

needs

Identify hidden strengths or

underutilized resources

Outcome of a needs assessment

Alignment of actions with identified needs

Garner greater support and involve more

people in subsequent action

Give voice to individuals in the community

who have not traditionally been solicited for

comment

61

Nut and Bolt #3

Funding for SBHCs

62

Maslow’s Hierarchy of Need

It’s hard to focus on

best practice standards

when your needs are

rooted in basic survival.

School health clinics

fight for lives

Karina BlandThe Arizona RepublicMarch 12, 2001

63

Foundations

Federal Public

Grants

Local

Funding/

Community

Partners

State Public

Grants

SCHIP

Medicaid

Private insurance

Patient fees

Federal entitlement programs

administered at the state level

MCHB/Title V

CDC HIV/AIDS Prevention

SAMHSA/Title XIX (substance abuse

and mental health screening and early

intervention)

Title XX/ Soc Services Block Grant

(TANF, daycare, child neglect and

abuse)

State Funding

State General Revenue

Tobacco Tax/Settlement

Education

NCLB /ESEA (Title I improving

academic achievement of the

disadvantaged and Title IV safe and

drug free schools)

IDEA (health-related special

education services)

BPHC/FQHC (Section 330 of

the Public Health Service Act)

Title X of the Public Health

Service Act: Family Planning

Figure 1 School-Based Health Center Funding Models

Patient revenue

Foundations that commonly

supports school-based health

care

Robert Wood Johnson

Foundation

KB Reynolds Charitable Trust

WKKF Kellogg Foundation

Welborn Foundation

McKesson Foundation

Duke Endowment

Health Foundation of Greater

Cincinnati

Visit the Grantsmanship Center

at http://www.tgci.com/ and the

Foundation Center at

http://fdncenter.org for other

foundation funding

opportunities

Local Funding

Public and private grants (e.g.,

universities, United Way)

City/county funds

Local businesses (e.g., banks,

insurance companies)

Community Partners

In-Kind Contributions from schools,

hospitals, health departments,

community health departments, and

community agencies (e.g., staff,

facilities, supplies)

Examples of Partners

Parents’ employers

Parents’ health insurance agencies

Local businesses

School districts

Universities

65

Nut and Bolt #4Developing a Case Statement for a

School-Based Health Center

66

Case Statement Content

Purpose

– What you propose to do / what are you

seeking funding for

– Summary of needs assessment findings

– Partners/collaborators and their

contributors

67


Service design

– Model

– Services

– Staffing

– Hours of operation

– Parent, student, and school staff

involvement

– Community, collaborator/partner

involvement

68


Current project support /infrastructure

– Sponsoring organizations

– Health center planning group activities

– In-kind contributions of

partners/collaborators

– Implementation grant possibilities

Proposed Budget

70

Nut and Bolt #5

Communications and the Media

Communications

Discipline that studies the principles of transmitting information and the methods by which it is delivered

72

Media Methods

Print media

Broadcast media

Social Media

Access to the media is access to the public

Know the types of stories publication(s) or station(s)

cover and how they report the news

Be an available information resource

Don’t be afraid to approach them with an issue or a

story idea

Keep relationships friendly and honest

Remember, they are doing their job—try to make it

easier for them

Communicating with the Media

Strategic communications strategies

News releases, Letters to the Editor, Op Eds

Blogs

E-newsletters and e-blasts

Referral network

Online resources

The Children’s Aid Society

Community Schools

School–Based Health Centers

Lisa Handwerker, MD, FAAP

Medical Director



Community Schools

The first school was Salomé Ureña de Henriquez Middle Academies, opened in March of 1992, followed by PS 5 which opened in 1993


Community Schools Both schools started

as full-service schools– before and after

school programs

– parent involvement programs

– adult education

– health

dental

medical

mental health

CAS Developmental Triangle

services that remove barriers to learning

• physical health• dental health

• mental health• social services

Key Program Components

After-School and Summer Enrichment

Parent Involvement

Adult Education

Medical, Dental, Mental Health and Social Services

Early Childhood

Community and Economic Development


Community Schools Model17 Community Schools in New York City 100% have Out of School Time

– 100% after school programs

– 65% (11/17) Summer programs

– 47% (8/17) Saturday and/or Holiday programs

76% (13/17) have Youth Development programs

47% (8/17) offer Family Support Services 82% (14/17) offer Adult Programs

CAS Community Schools

Health Services

71% (12/17) have Health Services

Medical

– 6 on-site

– 6 school linked

Dental

– 4 on-site

– 7 school linked

Mental Health

– 12 on-site


School-Based Health Services

5 full service SBHC’s

In 2008/2009 school year

– Total School enrollment: 4544

– Total clinic enrollment: 4026

(89% of school population)


School-Based Health ServicesTotal number of visits: 37,533 >55% of visits were to a

health care provider– 46% to a medical practitioner

– 23% to a dental practitioner

– 31% to a mental health practitioner

Benefits of a SBHC within a

Community School

Communication with principal and school staff

Integration of services

Parent communication

FERPA

Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

Generally, schools must have written permission from the parent or eligible student in order to release any information from a student's education record.

FERPA

FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions:

– School officials with legitimate educational

interests

– Appropriate officials in cases of health

and safety emergencies

HIPAA

HIPAA (the Federal Health Insurance Portability and Accountability Act) is federal legislation that protects patient health information. It pertains to individuals receiving care from health professionals. Other than doctors, nurses, mental health counselors or dentists, this may include, for example, pharmacists, clinical health educators, physical therapists, and all health related office staff.

Anyone who has indirect or direct patient contact or access to health information must abide by HIPAA.

HIPAA

WHAT HEALTH INFORMATION IS PROTECTED

Information regarding an individual’s health condition (such as any disease the patient may have);

Information about healthcare services individuals have received or potentially may receive in the future.

Challenges of a SBHC within a

community school Expectations for

information sharing

Boundaries

Expectations for SBHC center staff to be involved in all community schools activities

A great place to work!

SBHC 101: Nuts and Bolts of Starting a ... - Community Schools › assets › 1 › AssetManager...Successful School-Based Health Center in a Community School Laura Brey, MS, NASBHC

Documents